51
|
Krause A, Schönau E, Gollhofer A, Duran I, Ferrari-Malik A, Freyler K, Ritzmann R. Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility. Front Neurol 2017; 8:416. [PMID: 28861038 PMCID: PMC5561012 DOI: 10.3389/fneur.2017.00416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Individuals suffering from cerebral palsy (CP) often have involuntary, reflex-evoked muscle activity resulting in spastic hyperreflexia. Whole-body vibration (WBV) has been demonstrated to reduce reflex activity in healthy subjects, but evidence in CP patients is still limited. Therefore, this study aimed to establish the acute neuromuscular and kinematic effects of WBV in subjects with spastic CP. METHODS 44 children with spastic CP were tested on neuromuscular activation and kinematics before and immediately after a 1-min bout of WBV (16-25 Hz, 1.5-3 mm). Assessment included (1) recordings of stretch reflex (SR) activity of the triceps surae, (2) electromyography (EMG) measurements of maximal voluntary muscle activation of lower limb muscles, and (3) neuromuscular activation during active range of motion (aROM). We recorded EMG of m. soleus (SOL), m. gastrocnemius medialis (GM), m. tibialis anterior, m. vastus medialis, m. rectus femoris, and m. biceps femoris. Angular excursion was recorded by goniometry of the ankle and knee joint. RESULTS After WBV, (1) SOL SRs were decreased (p < 0.01) while (2) maximal voluntary activation (p < 0.05) and (3) angular excursion in the knee joint (p < 0.01) were significantly increased. No changes could be observed for GM SR amplitudes or ankle joint excursion. Neuromuscular coordination expressed by greater agonist-antagonist ratios during aROM was significantly enhanced (p < 0.05). DISCUSSION The findings point toward acute neuromuscular and kinematic effects following one bout of WBV. Protocols demonstrate that pathological reflex responses are reduced (spinal level), while the execution of voluntary movement (supraspinal level) is improved in regards to kinematic and neuromuscular control. This facilitation of muscle and joint control is probably due to a reduction of spasticity-associated spinal excitability in favor of giving access for greater supraspinal input during voluntary motor control.
Collapse
Affiliation(s)
- Anne Krause
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Eckhard Schönau
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Albert Gollhofer
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Anja Ferrari-Malik
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Kathrin Freyler
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Ritzmann
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| |
Collapse
|
52
|
Prochazka A. Neurophysiology and neural engineering: a review. J Neurophysiol 2017; 118:1292-1309. [PMID: 28566462 PMCID: PMC5558026 DOI: 10.1152/jn.00149.2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022] Open
Abstract
Neurophysiology is the branch of physiology concerned with understanding the function of neural systems. Neural engineering (also known as neuroengineering) is a discipline within biomedical engineering that uses engineering techniques to understand, repair, replace, enhance, or otherwise exploit the properties and functions of neural systems. In most cases neural engineering involves the development of an interface between electronic devices and living neural tissue. This review describes the origins of neural engineering, the explosive development of methods and devices commencing in the late 1950s, and the present-day devices that have resulted. The barriers to interfacing electronic devices with living neural tissues are many and varied, and consequently there have been numerous stops and starts along the way. Representative examples are discussed. None of this could have happened without a basic understanding of the relevant neurophysiology. I also consider examples of how neural engineering is repaying the debt to basic neurophysiology with new knowledge and insight.
Collapse
Affiliation(s)
- Arthur Prochazka
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
53
|
Bravo-Esteban E, Taylor J, Aleixandre M, Simón-Martínez C, Torricelli D, Pons JL, Avila-Martín G, Galán-Arriero I, Gómez-Soriano J. Longitudinal estimation of intramuscular Tibialis Anterior coherence during subacute spinal cord injury: relationship with neurophysiological, functional and clinical outcome measures. J Neuroeng Rehabil 2017; 14:58. [PMID: 28619087 PMCID: PMC5472888 DOI: 10.1186/s12984-017-0271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 06/05/2017] [Indexed: 12/11/2022] Open
Abstract
Background Estimation of surface intramuscular coherence has been used to indirectly assess pyramidal tract activity following spinal cord injury (SCI), especially within the 15-30 Hz bandwidth. However, change in higher frequency (>40 Hz) muscle coherence during SCI has not been characterised. Thus, the objective of this study was to identify change of high and low frequency intramuscular Tibialis Anterior (TA) coherence during incomplete subacute SCI. Methods Fifteen healthy subjects and 22 subjects with motor incomplete SCI (American Spinal Injury Association Impairment Scale, AIS, C or D grade) were recruited and tested during 4 sessions performed at 2-week intervals up to 8 months after SCI. Intramuscular TA coherence estimation was calculated within the 10–60 Hz bandwidth during controlled maximal isometric and isokinetic foot dorsiflexion. Maximal voluntary dorsiflexion torque, gait function measured with the WISCI II scale, and TA motor evoked potentials (MEP) were recorded. Results During subacute SCI, significant improvement in total lower limb manual muscle score, TA muscle strength and gait function were observed. No change in TA MEP amplitude was identified. Significant increase in TA coherence was detected in the 40–60 Hz, but not the 15–30 Hz bandwidth. The spasticity syndrome was associated with lower 15-30 Hz TA coherence during maximal isometric dorsiflexion and higher 10–60 Hz coherence during fast isokinetic movement (p < 0.05). Conclusions Longitudinal estimation of neurophysiological and clinical measures during subacute SCI suggest that estimation of TA muscle coherence during controlled movement provides indirect information regarding adaptive and maladaptive motor control mechanisms during neurorehabilitation.
Collapse
Affiliation(s)
- Elisabeth Bravo-Esteban
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Neurorehabilitation Group, Instituto Cajal, CSIC, Madrid, Spain.,Toledo Physiotherapy Research Group (GIFTO), Nursing and Physiotherapy Faculty, Universidad de Castilla la Mancha, Toledo, Spain
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain. .,Stoke Mandeville Spinal Research, National Spinal Injuries Centre, Buckinghamshire Healthcare Trust, NHS, Aylesbury, UK. .,Harris Manchester College, University of Oxford, Oxford, UK.
| | | | | | | | - Jose Luis Pons
- Neurorehabilitation Group, Instituto Cajal, CSIC, Madrid, Spain
| | - Gerardo Avila-Martín
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Iriana Galán-Arriero
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Julio Gómez-Soriano
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Nursing and Physiotherapy Faculty, Universidad de Castilla la Mancha, Toledo, Spain
| |
Collapse
|
54
|
Urbin MA, Ozdemir RA, Tazoe T, Perez MA. Spike-timing-dependent plasticity in lower-limb motoneurons after human spinal cord injury. J Neurophysiol 2017; 118:2171-2180. [PMID: 28468994 DOI: 10.1152/jn.00111.2017] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 01/20/2023] Open
Abstract
Recovery of lower-limb function after spinal cord injury (SCI) likely depends on transmission in the corticospinal pathway. Here, we examined whether paired corticospinal-motoneuronal stimulation (PCMS) changes transmission at spinal synapses of lower-limb motoneurons in humans with chronic incomplete SCI and aged-matched controls. We used 200 pairs of stimuli where corticospinal volleys evoked by transcranial magnetic stimulation (TMS) over the leg representation of the motor cortex were timed to arrive at corticospinal-motoneuronal synapses of the tibialis anterior (TA) muscle 2 ms before antidromic potentials evoked in motoneurons by electrical stimulation of the common peroneal nerve (PCMS+) or when antidromic potentials arrived 15 or 28 ms before corticospinal volleys (PCMS-) on separate days. Motor evoked potentials (MEPs) elicited by TMS and electrical stimulation were measured in the TA muscle before and after each stimulation protocol. After PCMS+, the size of MEPs elicited by TMS and electrical stimulation increased for up to 30 min in control and SCI participants. Notably, this was accompanied by increases in TA electromyographic activity and ankle dorsiflexion force in both groups, suggesting that this plasticity has functional implications. After PCMS-, MEPs elicited by TMS and electrical stimulation were suppressed if afferent input from the common peroneal nerve reduced TA MEP size during paired stimulation in both groups. In conclusion, PCMS elicits spike-timing-dependent changes at spinal synapses of lower-limb motoneurons in humans and has potential to improve lower-limb motor output following SCI.NEW & NOTEWORTHY Approaches that aim to enhance corticospinal transmission to lower-limb muscles following spinal cord injury (SCI) are needed. We demonstrate that paired corticomotoneuronal stimulation (PCMS) can enhance plasticity at spinal synapses of lower-limb motoneurons in humans with and without SCI. We propose that PCMS has potential for improving motor output in leg muscles in individuals with damage to the corticospinal tract.
Collapse
Affiliation(s)
- M A Urbin
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Recep A Ozdemir
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Toshiki Tazoe
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| |
Collapse
|
55
|
Mrachacz-Kersting N, Stevenson AJT. Paired Associative Stimulation Targeting the Tibialis Anterior Muscle using either Mono or Biphasic Transcranial Magnetic Stimulation. Front Hum Neurosci 2017; 11:197. [PMID: 28473764 PMCID: PMC5397406 DOI: 10.3389/fnhum.2017.00197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/04/2017] [Indexed: 12/02/2022] Open
Abstract
Paired associative stimulation (PAS) protocols induce plastic changes within the motor cortex. The objectives of this study were to investigate PAS effects targeting the tibialis anterior (TA) muscle using a biphasic transcranial magnetic stimulation (TMS) pulse form and, to determine whether a reduced intensity of this pulse would lead to significant changes as has been reported for hand muscles using a monophasic TMS pulse. Three interventions were investigated: (1) suprathreshold PAbi-PAS (n = 11); (2) suprathreshold PAmono-PAS (n = 11) where PAS was applied using a biphasic or monophasic pulse form at 120% resting motor threshold (RMT); (3) subthreshold PAbi-PAS (n = 10) where PAS was applied as for (1) at 95% active motor threshold (AMT). The peak-to-peak motor evoked potentials (MEPs) were quantified prior to, immediately following, and 30 min after the cessation of the intervention. TA MEP size increased significantly for all interventions immediately post (61% for suprathreshold PAbi-PAS, 83% for suprathreshold PAmono-PAS, 55% for subthreshold PAbi-PAS) and 30 min after the cessation of the intervention (123% for suprathreshold PAbi-PAS, 105% for suprathreshold PAmono-PAS, 80% for subthreshold PAbi-PAS. PAS using a biphasic pulse form at subthreshold intensities induces similar effects to conventional PAS.
Collapse
Affiliation(s)
- Natalie Mrachacz-Kersting
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| | - Andrew J T Stevenson
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| |
Collapse
|
56
|
Goetz SM, Deng ZD. The development and modelling of devices and paradigms for transcranial magnetic stimulation. Int Rev Psychiatry 2017; 29:115-145. [PMID: 28443696 PMCID: PMC5484089 DOI: 10.1080/09540261.2017.1305949] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
Magnetic stimulation is a non-invasive neurostimulation technique that can evoke action potentials and modulate neural circuits through induced electric fields. Biophysical models of magnetic stimulation have become a major driver for technological developments and the understanding of the mechanisms of magnetic neurostimulation and neuromodulation. Major technological developments involve stimulation coils with different spatial characteristics and pulse sources to control the pulse waveform. While early technological developments were the result of manual design and invention processes, there is a trend in both stimulation coil and pulse source design to mathematically optimize parameters with the help of computational models. To date, macroscopically highly realistic spatial models of the brain, as well as peripheral targets, and user-friendly software packages enable researchers and practitioners to simulate the treatment-specific and induced electric field distribution in the brains of individual subjects and patients. Neuron models further introduce the microscopic level of neural activation to understand the influence of activation dynamics in response to different pulse shapes. A number of models that were designed for online calibration to extract otherwise covert information and biomarkers from the neural system recently form a third branch of modelling.
Collapse
Affiliation(s)
- Stefan M Goetz
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- b Department of Electrical & Computer Engineering , Duke University , Durham , NC , USA
- c Department of Neurosurgery , Duke University , Durham , NC , USA
| | - Zhi-De Deng
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- d Intramural Research Program, Experimental Therapeutics & Pathophysiology Branch, Noninvasive Neuromodulation Unit , National Institutes of Health, National Institute of Mental Health , Bethesda , MD , USA
- e Duke Institute for Brain Sciences , Duke University , Durham , NC , USA
| |
Collapse
|
57
|
Petersen JA, Spiess M, Curt A, Weidner N, Rupp R, Abel R, Schubert M. Upper Limb Recovery in Spinal Cord Injury: Involvement of Central and Peripheral Motor Pathways. Neurorehabil Neural Repair 2017; 31:432-441. [PMID: 28132610 DOI: 10.1177/1545968316688796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The course of central and peripheral motor recovery after cervical spinal cord injury (SCI) may be investigated by electrophysiological measures. The goal of this study was to compare the 2 over the first year after injury in relation to motor gains. METHODS Compound motor action potentials (CMAPs), motor-evoked potentials (MEPs), and F-waves were recorded from the abductor digiti minimi and CMAP and F-waves from abductor hallucis muscles in 305 patients at about 15 days, 1 month, 3 months, 6 months, and 12 months following an acute traumatic SCI. RESULTS The MEP amplitudes and F-wave persistences were lower with more severe sensorimotor impairment. They steadily increased in most subgroups within 6 months after SCI. The amplitude of the CMAPs was low for the first 3 months in the most severely affected participants. This was also found for CMAPs from tibial nerve originating well below the cervical lesion level. Improvement in neurophysiological parameters correlated with improved upper extremity motor scores. CONCLUSION The results point to a systematic interrelation of corticospinal transmission, spinal motoneuron excitability, and its axon function, respectively. Electrophysiological correlates of neural excitability show distinct spatial and temporal interrelations within central and peripheral motor pathways following acute cervical SCI. A strong secondary deterioration within the peripheral motor system with incomplete or no recovery depends on anatomical distance caudal to lesion and on lesion severity. Electrophysiological assessments may increase the sensitivity of interventional studies in addition to clinical measures.
Collapse
Affiliation(s)
- Jens A Petersen
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland.,3 University Hospital Balgrist, Zurich, Switzerland
| | | | - Armin Curt
- 3 University Hospital Balgrist, Zurich, Switzerland
| | | | - Rüdiger Rupp
- 4 Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Abel
- 5 Spinal Cord Injury Center, Bayreuth, Germany
| | -
- 3 University Hospital Balgrist, Zurich, Switzerland
| | | |
Collapse
|
58
|
Nardone R, Orioli A, Golaszewski S, Brigo F, Sebastianelli L, Höller Y, Frey V, Trinka E. Passive cycling in neurorehabilitation after spinal cord injury: A review. J Spinal Cord Med 2017; 40:8-16. [PMID: 27841091 PMCID: PMC5376131 DOI: 10.1080/10790268.2016.1248524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
CONTEXT/OBJECTIVE Passive cycling (PC) may represent a potential alternative neurorehabilitation program for patients who are too weak or medically unstable to repeatedly practice active movements. We review here the most important animal and human studies addressing PC after spinal cord injury (SCI). METHODS A MEDLINE search was performed using following terms: "passive", "cycling", "pedaling", "pedalling","spinal cord injury". RESULTS Experimental studies revealed that PC modulated spinal reflex and reduced spasticity. PC also reduced autonomic dysreflexia and elicited cardio-protective effects. Increased levels of mRNA for brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor and neurotrophin-4 were found. In contrast, human studies failed to show an effect of PC on spasticity reduction and did not support its application for prevention of cardiovascular disease-related secondary complications. CONCLUSION Available evidence to support the use of PC as standard treatment in patients with SCI is still rather limited. Since it is conceivable that PC motion could elicit sensory inputs to activate cortical structures and induce cortical plasticity changes leading to improved lower limb motor performance, further carefully designed prospective studies in subjects with SCI are needed.
Collapse
Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria,Correspondence to: Raffaele Nardone, Department of Neurology – “F. Tappeiner” Hospital – Meran/o, Via Rossini, 5, 39012 Meran/o (BZ) – Italy. E-mail address:
| | - Andrea Orioli
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Department of Neurological and Movement Sciences. Section of Clinical Neurology, University of Verona, Italy
| | | | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
59
|
Field-Fote EC, Yang JF, Basso DM, Gorassini MA. Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury. J Neurotrauma 2016; 34:1813-1825. [PMID: 27673569 DOI: 10.1089/neu.2016.4565] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.
Collapse
Affiliation(s)
- Edelle C Field-Fote
- 1 Shepherd Center, Crawford Research Institute and Division of Physical Therapy, Emory University , Atlanta, Georgia
| | - Jaynie F Yang
- 2 Department of Physical Therapy, Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - D Michele Basso
- 3 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio
| | - Monica A Gorassini
- 4 Department of Biomedical Engineering, Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta, Canada
| |
Collapse
|
60
|
Powell ES, Carrico C, Raithatha R, Salyers E, Ward A, Sawaki L. Transvertebral direct current stimulation paired with locomotor training in chronic spinal cord injury: A case study. NeuroRehabilitation 2016; 38:27-35. [PMID: 26889795 DOI: 10.3233/nre-151292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN This double-blind, sham-controlled, crossover case study combined transvertebral direct current stimulation (tvDCS) and locomotor training on a robot-assisted gait orthosis (LT-RGO). OBJECTIVE Determine whether cathodal tvDCS paired with LT-RGO leads to greater changes in function and neuroplasticity than sham tvDCS paired with LT-RGO. SETTING University of Kentucky (UK) HealthCare Stroke and Spinal Cord Neurorehabilitation Research at HealthSouth Cardinal Hill Hospital. METHODS A single subject with motor incomplete spinal cord injury (SCI) participated in 24 sessions of sham tvDCS paired with LT-RGO before crossover to 24 sessions of cathodal tvDCS paired with LT-RGO. Functional outcomes were measured with 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Spinal Cord Independence Measure-III (SCIM-III) mobility component, lower extremity manual muscle test (MMT), and Berg Balance Scale (BBS). Corticospinal changes were assessed using transcranial magnetic stimulation. RESULTS Improvement in 10MWT speed, SCIM-III mobility component, and BBS occurred with both conditions. 6MWT worsened after sham tvDCS and improved after cathodal tvDCS. MMT scores for both lower extremities improved following sham tvDCS but decreased following cathodal tvDCS. Corticospinal excitability increased following cathodal tvDCS but not sham tvDCS. CONCLUSION These results suggest that combining cathodal tvDCS and LT-RGO may improve functional outcomes, increase corticospinal excitability, and possibly decrease spasticity. Randomized controlled trials are needed to confirm these conclusions. SPONSORSHIP This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117, and the HealthSouth Cardinal Hill Stroke and Spinal Cord Endowment (1215375670).
Collapse
Affiliation(s)
- Elizabeth Salmon Powell
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Cheryl Carrico
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Ravi Raithatha
- University of Pikeville Kentucky College of Medicine, Pikeville, KY, USA
| | - Emily Salyers
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Andrea Ward
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Lumy Sawaki
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.,HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
| |
Collapse
|
61
|
Training-Specific Neural Plasticity in Spinal Reflexes after Incomplete Spinal Cord Injury. Neural Plast 2016; 2016:6718763. [PMID: 27725887 PMCID: PMC5048024 DOI: 10.1155/2016/6718763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022] Open
Abstract
The neural plasticity of spinal reflexes after two contrasting forms of walking training was determined in individuals with chronic, motor-incomplete spinal cord injury (SCI). Endurance Training involved treadmill walking for as long as possible, and Precision Training involved walking precisely over obstacles and onto targets overground. Twenty participants started either Endurance or Precision Training for 2 months and then crossed over after a 2-month rest period to the other form of training for 2 months. Measures were taken before and after each phase of training and rest. The cutaneomuscular reflex (CMR) during walking was evoked in the soleus (SOL) and tibialis anterior muscles by stimulating the posterior tibial nerve at the ankle. Clonus was estimated from the EMG power in the SOL during unperturbed walking. The inhibitory component of the SOL CMR was enhanced after Endurance but not Precision Training. Clonus did not change after either form of training. Participants with lower reflex excitability tended to be better walkers (i.e., faster walking speeds) prior to training, and the reduction in clonus was significantly correlated with the improvement in walking speed and distance. Thus, reflex excitability responded in a training-specific way, with the reduction in reflex excitability related to improvements in walking function. Trial registration number is NCT01765153.
Collapse
|
62
|
Osuna-Carrasco LP, López-Ruiz JR, Mendizabal-Ruiz EG, De la Torre-Valdovinos B, Bañuelos-Pineda J, Jiménez-Estrada I, Dueñas-Jiménez SH. Quantitative analysis of hindlimbs locomotion kinematics in spinalized rats treated with Tamoxifen plus treadmill exercise. Neuroscience 2016; 333:151-61. [PMID: 27450566 DOI: 10.1016/j.neuroscience.2016.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/27/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
Abstract
Locomotion recovery after a spinal cord injury (SCI) includes axon regeneration, myelin preservation and increased plasticity in propriospinal and descending spinal circuitries. The combined effects of tamoxifen and exercise after a SCI were analyzed in this study to determine whether the combination of both treatments induces the best outcome in locomotion recovery. In this study, the penetrating injury was provoked by a sharp projectile that penetrates through right dorsal and ventral portions of the T13-L1 spinal segments, affecting propriospinal and descending/ascending tracts. Intraperitoneal application of Tamoxifen and a treadmill exercise protocol, as rehabilitation therapies, separately or combined, were used. To evaluate the functional recovery, angular patterns of the hip, knee and ankle joints as well as the leg pendulum-like movement (PLM) were measured during the unrestricted gait of treated and untreated (UT) animals, previously and after the traumatic injury (15 and 30days post-injury (dpi)). A pattern (curve) comparison analysis was made by using a locally designed Matlab script that determines the Frechet dissimilarity. The SCI magnitude was assessed by qualitative and quantitative histological analysis of the injury site 30days after SCI. Our results showed that all treated groups had an improvement in hindlimbs kinematics compared to the UT group, which showed a poor gait locomotion recovery throughout the rehabilitation period. The group with the combined treatment (tamoxifen+exercise (TE)) presented the best outcome. In conclusion, tamoxifen and treadmill exercise treatments are complementary therapies for the functional recovery of gait locomotion in hemi-spinalized rats.
Collapse
Affiliation(s)
- L P Osuna-Carrasco
- Department of Neuroscience, CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | - J R López-Ruiz
- Department of Neuroscience, CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | - J Bañuelos-Pineda
- Department of Veterinary Medicine, CUCBA, Universidad de Guadalajara, Mexico
| | - I Jiménez-Estrada
- Department of Physiology, Biophysics and Neurosciences, CINVESTAV, IPN, México City, Mexico
| | - S H Dueñas-Jiménez
- Department of Neuroscience, CUCS, Universidad de Guadalajara, Guadalajara, Mexico.
| |
Collapse
|
63
|
Kumar S, Dey S, Jain S. Extremely low-frequency electromagnetic fields: A possible non-invasive therapeutic tool for spinal cord injury rehabilitation. Electromagn Biol Med 2016; 36:88-101. [PMID: 27399648 DOI: 10.1080/15368378.2016.1194290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Traumatic insults to the spinal cord induce both immediate mechanical damage and subsequent tissue degeneration. The latter involves a range of events namely cellular disturbance, homeostatic imbalance, ionic and neurotransmitters derangement that ultimately result in loss of sensorimotor functions. The targets for improving function after spinal cord injury (SCI) are mainly directed toward limiting these secondary injury events. Extremely low-frequency electromagnetic field (ELF-EMF) is a possible non-invasive therapeutic intervention for SCI rehabilitation which has the potential to constrain the secondary injury-induced events. In the present review, we discuss the effects of ELF-EMF on experimental and clinical SCI as well as on biological system.
Collapse
Affiliation(s)
- Suneel Kumar
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India.,b W. M. Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey , Piscataway , NJ , USA
| | - Soumil Dey
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India
| | - Suman Jain
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India
| |
Collapse
|
64
|
Nardone R, Langthaler PB, Bathke AC, Höller Y, Brigo F, Lochner P, Christova M, Trinka E. Effects of passive pedaling exercise on the intracortical inhibition in subjects with spinal cord injury. Brain Res Bull 2016; 124:144-9. [DOI: 10.1016/j.brainresbull.2016.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/16/2016] [Accepted: 04/20/2016] [Indexed: 01/13/2023]
|
65
|
Friedli L, Rosenzweig ES, Barraud Q, Schubert M, Dominici N, Awai L, Nielson JL, Musienko P, Nout-Lomas Y, Zhong H, Zdunowski S, Roy RR, Strand SC, van den Brand R, Havton LA, Beattie MS, Bresnahan JC, Bézard E, Bloch J, Edgerton VR, Ferguson AR, Curt A, Tuszynski MH, Courtine G. Pronounced species divergence in corticospinal tract reorganization and functional recovery after lateralized spinal cord injury favors primates. Sci Transl Med 2016; 7:302ra134. [PMID: 26311729 DOI: 10.1126/scitranslmed.aac5811] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Experimental and clinical studies suggest that primate species exhibit greater recovery after lateralized compared to symmetrical spinal cord injuries. Although this observation has major implications for designing clinical trials and translational therapies, advantages in recovery of nonhuman primates over other species have not been shown statistically to date, nor have the associated repair mechanisms been identified. We monitored recovery in more than 400 quadriplegic patients and found that functional gains increased with the laterality of spinal cord damage. Electrophysiological analyses suggested that corticospinal tract reorganization contributes to the greater recovery after lateralized compared with symmetrical injuries. To investigate underlying mechanisms, we modeled lateralized injuries in rats and monkeys using a lateral hemisection, and compared anatomical and functional outcomes with patients who suffered similar lesions. Standardized assessments revealed that monkeys and humans showed greater recovery of locomotion and hand function than did rats. Recovery correlated with the formation of corticospinal detour circuits below the injury, which were extensive in monkeys but nearly absent in rats. Our results uncover pronounced interspecies differences in the nature and extent of spinal cord repair mechanisms, likely resulting from fundamental differences in the anatomical and functional characteristics of the motor systems in primates versus rodents. Although rodents remain essential for advancing regenerative therapies, the unique response of the primate corticospinal tract after injury reemphasizes the importance of primate models for designing clinically relevant treatments.
Collapse
Affiliation(s)
- Lucia Friedli
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Ephron S Rosenzweig
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0662, USA
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Nadia Dominici
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, 1081 BT Amsterdam, Netherlands
| | - Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jessica L Nielson
- Department of Neurosurgery, University of California, San Francisco (UCSF), San Francisco, CA 94122, USA
| | - Pavel Musienko
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
| | - Yvette Nout-Lomas
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Hui Zhong
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Roland R Roy
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Sarah C Strand
- California National Primate Research Center, University of California, Davis, Davis, CA 95616-8542, USA
| | - Rubia van den Brand
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Leif A Havton
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1769, USA
| | | | | | - Erwan Bézard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France. CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
| | - Jocelyne Bloch
- Clinical Neuroscience, University Hospital of Vaud (CHUV), 1011 Lausanne, Switzerland
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Adam R Ferguson
- Department of Neurosurgery, University of California, San Francisco (UCSF), San Francisco, CA 94122, USA
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0662, USA. Veterans Administration Medical Center, San Diego, CA 92161, USA
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. Clinical Neuroscience, University Hospital of Vaud (CHUV), 1011 Lausanne, Switzerland.
| |
Collapse
|
66
|
Wu Q, Cao Y, Dong C, Wang H, Wang Q, Tong W, Li X, Shan C, Wang T. Neuromuscular interaction is required for neurotrophins-mediated locomotor recovery following treadmill training in rat spinal cord injury. PeerJ 2016; 4:e2025. [PMID: 27190721 PMCID: PMC4867713 DOI: 10.7717/peerj.2025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/19/2016] [Indexed: 01/01/2023] Open
Abstract
Recent results have shown that exercise training promotes the recovery of injured rat distal spinal cords, but are still unclear about the function of skeletal muscle in this process. Herein, rats with incomplete thoracic (T10) spinal cord injuries (SCI) with a dual spinal lesion model were subjected to four weeks of treadmill training and then were treated with complete spinal transection at T8. We found that treadmill training allowed the retention of hind limb motor function after incomplete SCI, even with a heavy load after complete spinal transection. Moreover, treadmill training alleviated the secondary injury in distal lumbar spinal motor neurons, and enhanced BDNF/TrkB expression in the lumbar spinal cord. To discover the influence of skeletal muscle contractile activity on motor function and gene expression, we adopted botulinum toxin A (BTX-A) to block the neuromuscular activity of the rat gastrocnemius muscle. BTX-A treatment inhibited the effects of treadmill training on motor function and BDNF/TrKB expression. These results indicated that treadmill training through the skeletal muscle-motor nerve-spinal cord retrograde pathway regulated neuralplasticity in the mammalian central nervous system, which induced the expression of related neurotrophins and promoted motor function recovery.
Collapse
Affiliation(s)
- Qinfeng Wu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Rehabilitation Medicine, affiliated Hospital of Nantong University, Nantong, China
| | - Yana Cao
- Jiangsu Province Hospital of TCM , Nanjing, Jiangsu , China
| | - Chuanming Dong
- Department of Anatomy and Neurobiology, Nantong University , Nantong, Jiangsu , China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu , China
| | - Qinghua Wang
- Laboratory Animal Center, Nantong University , Nantong, Jiangsu , China
| | - Weifeng Tong
- Research Center for Neurobiological, Xuzhou Medical Collage , Xuzhou, Jiangsu , China
| | - Xiangzhe Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu , China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Tong Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu , China
| |
Collapse
|
67
|
Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, Filoni S. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurol 2016; 16:12. [PMID: 26818847 PMCID: PMC4730780 DOI: 10.1186/s12883-016-0536-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury (SCI) is a severe neurological disorder associated not only with ongoing medical complications but also with a significant loss of mobility and participation. The introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. The aim of this preliminary report were to evaluate the efficacy, the feasibility and the changes in the mobility and in the de-adaptations of a new rehabilitative protocol for EKSO™ a robotic exoskeleton device in subjects with SCI disease with an impairment of lower limbs assessed by gait analysis and clinical outcomes. Method This is a pilot single case experimental A-B (pre-post) design study. Three cognitively intact voluntary participants with SCI and gait disorders were admitted. All subjects were submitted to a training program of robot walking sessions for 45 min daily over 20 sessions. The spatiotemporal parameters at the beginning (T0) and at the end of treatment (T1) were recorded. Other clinical assessments (6 min walking test and Timed Up and Go test) were acquired at T0 and T1. Results Robot training were feasible and acceptable and all participants completed the training sessions. All subjects showed improvements in gait spatiotemporal indexes (Mean velocity, Cadence, Step length and Step width) and in 6 min Walking Test (T0 versus T1). Conclusions Robot training is a feasible form of rehabilitation for people with SCI. Further investigation regarding long term effectiveness of robot training in time is necessary. Trial registration ClinicalTrials.gov NCT02065830.
Collapse
Affiliation(s)
- Patrizio Sale
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy.
| | | | - Michele Russo
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Francesco Piccione
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
| | - Rocco Salvatore Calabrò
- Neurobehavioral and Robotic Neurorehabilitation Laboratory Coordinator IRCCS Centro, Neurolesi "Bonino-Pulejo" Messina, Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
| |
Collapse
|
68
|
Alexeeva N, Calancie B. Efficacy of QuadroPulse rTMS for improving motor function after spinal cord injury: Three case studies. J Spinal Cord Med 2016; 39:50-7. [PMID: 25437531 PMCID: PMC4725792 DOI: 10.1179/2045772314y.0000000279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To examine the effects of repetitive QuadroPulse transcranial magnetic stimulation (rTMS(QP)) on hand/leg function after spinal cord injury (SCI). DESIGN Interventional proof-of-concept study. SETTING University laboratory. PARTICIPANTS Three adult subjects with cervical SCI. Interventions Repeated trains of magnetic stimuli were applied to the motor cortical hand/leg area. Several exploratory single-day rTMS(QP) protocols were examined. Ultimately we settled on a protocol using three 5-day trials of (1) rTMS(QP) only; (2) exercise only (targeting hand or leg function); and (3) rTMS(QP) combined with exercise. OUTCOME MEASURES Hand motor function was assessed by Purdue Pegboard and Complete Minnesota Dexterity tests. Walking function was based on treadmill walking and the Timed Up and Go test. Electromyographic recordings were used for neurophysiological testing of cortical (by single- and double-pulse TMS) and spinal (via tendon taps and electrical nerve stimulation) excitability. RESULTS Single-day rTMS(QP) application had no clear effect in the 2 subjects whose hand function was targeted, but improved walking speed in the person targeted for walking, accompanied by increased cortical excitability and reduced spinal excitability. All 3 subjects showed functional improvement following the 5-day rTMS(QP) intervention, an effect being even more pronounced after the five-day combined rTMS(QP) + exercise sessions. There were no rTMS(QP)-associated adverse effects. CONCLUSION Our findings suggest a functional benefit of motor cortical rTMS(QP) after SCI. The effect of rTMS(QP) appears to be augmented when stimulation is accompanied by targeted exercises, warranting expansion of this pilot study to a larger subject population.
Collapse
Affiliation(s)
| | - Blair Calancie
- Correspondence to: Blair Calancie, Department of Neurosurgery, SUNY Upstate Medical University, 750 E. Adams St, IHP #1213, Syracuse, NY 13210, USA.
| |
Collapse
|
69
|
|
70
|
Foffani G, Shumsky J, Knudsen EB, Ganzer PD, Moxon KA. Interactive Effects Between Exercise and Serotonergic Pharmacotherapy on Cortical Reorganization After Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:479-89. [PMID: 26338432 DOI: 10.1177/1545968315600523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In rat models of spinal cord injury, at least 3 different strategies can be used to promote long-term cortical reorganization: (1) active exercise above the level of the lesion; (2) passive exercise below the level of the lesion; and (3) serotonergic pharmacotherapy. Whether and how these potential therapeutic strategies-and their underlying mechanisms of action-interact remains unknown. Methods In spinally transected adult rats, we compared the effects of active exercise above the level of the lesion (treadmill), passive exercise below the level of the lesion (bike), serotonergic pharmacotherapy (quipazine), and combinations of the above therapies (bike+quipazine, treadmill+quipazine, bike+treadmill+quipazine) on long-term cortical reorganization (9 weeks after the spinal transection). Cortical reorganization was measured as the percentage of cells recorded in the deafferented hindlimb cortex that responded to tactile stimulation of the contralateral forelimb. Results Bike and quipazine are "competing" therapies for cortical reorganization, in the sense that quipazine limits the cortical reorganization induced by bike, whereas treadmill and quipazine are "collaborative" therapies, in the sense that the reorganization induced by quipazine combined with treadmill is greater than the reorganization induced by either quipazine or treadmill. CONCLUSIONS These results uncover the interactive effects between active/passive exercise and serotonergic pharmacotherapy on cortical reorganization after spinal cord injury, emphasizing the importance of understanding the effects of therapeutic strategies in spinal cord injury (and in other forms of deafferentation) from an integrated system-level approach.
Collapse
Affiliation(s)
- Guglielmo Foffani
- Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla-La Mancha, Toledo, Spain Hospitales de Madrid, Móstoles, Spain CEU-San Pablo University, Madrid, Spain
| | - Jed Shumsky
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Karen A Moxon
- Drexel University College of Medicine, Philadelphia, PA, USA Drexel University, Philadelphia, PA, USA
| |
Collapse
|
71
|
|
72
|
Duffell LD, Brown GL, Mirbagheri MM. Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury: Distinctions Revealed by Different Analytical Methods. Neurorehabil Neural Repair 2015; 29:566-76. [PMID: 25398727 PMCID: PMC4431959 DOI: 10.1177/1545968314558601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) results in impaired function, and ankle joint spasticity is a common secondary complication. Different interventions have been trialed with variable results. OBJECTIVE We investigated the effects of pharmacological and physical (locomotor training) interventions on function in people living with incomplete motor function loss caused by SCI and used different analytical techniques to understand whether functional levels affect recovery with different interventions. METHODS Participants with an incomplete SCI were assigned to 3 groups: no intervention, Lokomat, or tizanidine. Outcome measures were the 10-m walk test, 6-minute walk test, and the Timed Up and Go. Participants were classified in 2 ways: (1) based on achieving an improvement above the minimally important difference (MID) and (2) using growth mixture modeling (GMM). Functional levels of participants who achieved the MID were compared and random coefficient regression (RCR) was used to assess recovery in GMM classes. RESULTS Overall, walking speed and endurance improved, with no difference between interventions. Only a small number of participants achieved the MID. Both MID and GMM-RCR analyses revealed that tizanidine improved endurance in high-functioning participants. GMM-RCR classification also showed that speed and mobility improved after locomotor training. CONCLUSIONS Improvements in function were achieved in a limited number of people with SCI. Using the MID and GMM techniques, differences in responses to interventions between high-and low-functioning participants could be identified. These techniques may, therefore, have potential to be used for characterizing therapeutic effects resulting from different interventions.
Collapse
Affiliation(s)
| | | | - Mehdi M Mirbagheri
- Northwestern University, Chicago, IL, USA Rehabilitation Institute of Chicago, Chicago, IL, USA
| |
Collapse
|
73
|
Awai L, Curt A. Comprehensive assessment of walking function after human spinal cord injury. PROGRESS IN BRAIN RESEARCH 2015; 218:1-14. [PMID: 25890130 DOI: 10.1016/bs.pbr.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Regaining any locomotor function after spinal cord injury is not only of immediate importance for affected patients but also for clinical research as it allows to investigate mechanisms underlying motor impairment and locomotor recovery. Clinical scores inform on functional outcomes that are clinically meaningful to value effects of therapy while they all lack the ability to explain underlying mechanisms of recovery. For this purpose, more elaborate recordings of walking kinematics combined with assessments of spinal cord conductivity and muscle activation patterns are required. A comprehensive assessment framework comprising of multiple complementary modalities is necessary. This will not only allow for capturing even subtle changes induced by interventions that are likely missed by standard clinical outcome measures. It will be fundamental to attribute observed changes to naturally occurring spontaneous recovery in contrast to specific changes induced by novel therapeutic interventions beyond the improvements achieved by conventional therapy.
Collapse
Affiliation(s)
- Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| |
Collapse
|
74
|
Does locomotor training improve pulmonary function in patients with spinal cord injury? Spinal Cord 2015; 53:467-70. [PMID: 25687515 DOI: 10.1038/sc.2014.251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 12/25/2014] [Accepted: 12/29/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of a locomotor training (LT) combined rehabilitation program with a rehabilitation-only program on pulmonary function in spinal cord injury (SCI) patients by investigating spirometric analyses of the patients. SETTING Rehabilitation center in Ankara, Turkey. METHODS Fifty-two patients (40 male, 12 female) with SCI enrolled in the study. The subjects were divided into two groups: the first group (group A) received both LT and a rehabilitation program and the second group (group B) received only the rehabilitation program for 4 weeks. The LT program was prescribed as three 30-min sessions per week. Pulmonary function was evaluated spirometrically in both groups before and after the rehabilitation program. RESULTS The spirometric values of the SCI patients, including forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow rate and vital capacity (VC) and VC%, increased significantly with LT in the first group (all P<0.05). Maximum voluntary ventilation values increased significantly in both groups (both P<0.05). CONCLUSION These findings suggest that LT is effective for improving pulmonary function in SCI patients. We also highlight the useful effects of LT, which are likely the result of erect posture, gait and neuroplastic changes that prevent potential complications in SCI patients.
Collapse
|
75
|
Efficient and reliable characterization of the corticospinal system using transcranial magnetic stimulation. J Clin Neurophysiol 2015; 31:246-52. [PMID: 24887609 DOI: 10.1097/wnp.0000000000000057] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study is to develop a method to reliably characterize multiple features of the corticospinal system in a more efficient manner than typically done in transcranial magnetic stimulation studies. METHODS Forty transcranial magnetic stimulation pulses of varying intensity were given over the first dorsal interosseous motor hot spot in 10 healthy adults. The first dorsal interosseous motor-evoked potential size was recorded during rest and activation to create recruitment curves. The Boltzmann sigmoidal function was fit to the data, and parameters relating to maximal motor-evoked potential size, curve slope, and stimulus intensity leading to half-maximal motor-evoked potential size were computed from the curve fit. RESULTS Good to excellent test-retest reliability was found for all corticospinal parameters at rest and during activation with 40 transcranial magnetic stimulation pulses. CONCLUSIONS Through the use of curve fitting, important features of the corticospinal system can be determined with fewer stimuli than typically used for the same information. Determining the recruitment curve provides a basis to understand the state of the corticospinal system and select subject-specific parameters for transcranial magnetic stimulation testing quickly and without unnecessary exposure to magnetic stimulation. This method can be useful in individuals who have difficulty in maintaining stillness, including children and patients with motor disorders.
Collapse
|
76
|
Lam T, Pauhl K, Ferguson A, Malik RN, Krassioukov A, Eng JJ. Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study. ACTA ACUST UNITED AC 2015; 52:113-29. [DOI: 10.1682/jrrd.2014.03.0090] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/10/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Amanda Ferguson
- NeuroMotion Physical Therapy, Vancouver, British Columbia, Canada
| | | | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, the University of British Columbia, Vancouver, British Columbia, Canada;Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J. Eng
- International Collaboration on Repair Discoveries, the University of British Columbia, Vancouver, British Columbia, Canada;GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | | |
Collapse
|
77
|
Facilitation of descending excitatory and spinal inhibitory networks from training of endurance and precision walking in participants with incomplete spinal cord injury. PROGRESS IN BRAIN RESEARCH 2015; 218:127-55. [DOI: 10.1016/bs.pbr.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
78
|
Hudson HM, Griffin DM, Belhaj-Saïf A, Cheney PD. Properties of primary motor cortex output to hindlimb muscles in the macaque monkey. J Neurophysiol 2014; 113:937-49. [PMID: 25411454 DOI: 10.1152/jn.00099.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The cortical control of forelimb motor function has been studied extensively, especially in the primate. In contrast, cortical control of the hindlimb has been relatively neglected. This study assessed the output properties of the primary motor cortex (M1) hindlimb representation in terms of the sign, latency, magnitude, and distribution of effects in stimulus-triggered averages (StTAs) of electromyography (EMG) activity recorded from 19 muscles, including hip, knee, ankle, digit, and intrinsic foot muscles, during a push-pull task compared with data reported previously on the forelimb. StTAs (15, 30, and 60 μA at 15 Hz) of EMG activity were computed at 317 putative layer V sites in two rhesus macaques. Poststimulus facilitation (PStF) was distributed equally between distal and proximal muscles, whereas poststimulus suppression (PStS) was more common in distal muscles than proximal muscles (51/49%, respectively, for PStF; 72/28%, respectively, for PStS) at 30 μA. Mean PStF and PStS onset latency generally increased the more distal the joint of a muscle's action. Most significantly, the average magnitude of hindlimb poststimulus effects was considerably weaker than the average magnitude of effects from forelimb M1. In addition, forelimb PStF magnitude increased consistently from proximal to distal joints, whereas hindlimb PStF magnitude was similar at all joints except the intrinsic foot muscles, which had a magnitude of approximately double that of all of the other muscles. The results suggest a greater monosynaptic input to forelimb compared with hindlimb motoneurons, as well as a more direct synaptic linkage for the intrinsic foot muscles compared with the other hindlimb muscles.
Collapse
Affiliation(s)
- Heather M Hudson
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Darcy M Griffin
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Abderraouf Belhaj-Saïf
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul D Cheney
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
79
|
Dong Y, Yang L, Yang L, Zhao H, Zhang C, Wu D. Transplantation of neurotrophin-3-transfected bone marrow mesenchymal stem cells for the repair of spinal cord injury. Neural Regen Res 2014; 9:1520-4. [PMID: 25317169 PMCID: PMC4192969 DOI: 10.4103/1673-5374.139478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 12/18/2022] Open
Abstract
Bone marrow mesenchymal stem cell transplantation has been shown to be therapeutic in the repair of spinal cord injury. However, the low survival rate of transplanted bone marrow mesenchymal stem cells in vivo remains a problem. Neurotrophin-3 promotes motor neuron survival and it is hypothesized that its transfection can enhance the therapeutic effect. We show that in vitro transfection of neurotrophin-3 gene increases the number of bone marrow mesenchymal stem cells in the region of spinal cord injury. These results indicate that neurotrophin-3 can promote the survival of bone marrow mesenchymal stem cells transplanted into the region of spinal cord injury and potentially enhance the therapeutic effect in the repair of spinal cord injury.
Collapse
Affiliation(s)
- Yuzhen Dong
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| | - Libin Yang
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| | - Lin Yang
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| | - Hongxing Zhao
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| | - Chao Zhang
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| | - Dapeng Wu
- Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan Province, China
| |
Collapse
|
80
|
Smith AC, Rymer WZ, Knikou M. Locomotor training modifies soleus monosynaptic motoneuron responses in human spinal cord injury. Exp Brain Res 2014; 233:89-103. [PMID: 25205562 DOI: 10.1007/s00221-014-4094-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/29/2014] [Indexed: 01/15/2023]
Abstract
The objective of this study was to assess changes in monosynaptic motoneuron responses to stimulation of Ia afferents after locomotor training in individuals with chronic spinal cord injury (SCI). We hypothesized that locomotor training modifies the amplitude of the soleus monosynaptic motoneuron responses in a body position-dependent manner. Fifteen individuals with chronic clinical motor complete or incomplete SCI received an average of 45 locomotor training sessions. The soleus H-reflex and M-wave recruitment curves were assembled using data collected in both the right and left legs, with subjects seated and standing, before and after training. The soleus H-reflexes and M-waves, measured as peak-to-peak amplitudes, were normalized to the maximal M-wave (M(max)). Stimulation intensities were normalized to 50% M(max) stimulus intensity. A sigmoid function was also fitted to the normalized soleus H-reflexes on the ascending limb of the recruitment curve. After training, soleus H-reflex excitability was increased in both legs in AIS C subjects, and remained unchanged in AIS A-B and AIS D subjects during standing. When subjects were seated, soleus H-reflex excitability was decreased after training in many AIS C and D subjects. Changes in reflex excitability coincided with changes in stimulation intensities at H-threshold, 50% maximal H-reflex, and at maximal H-reflex, while an interaction between leg side and AIS scale for the H-reflex slope was also found. Adaptations of the intrinsic properties of soleus motoneurons and Ia afferents, the excitability profile of the soleus motoneuron pool, oligosynaptic inputs, and corticospinal inputs may all contribute to these changes. The findings of this study demonstrate that locomotor training impacts the amplitude of the monosynaptic motoneuron responses based on the demands of the motor task in people with chronic SCI.
Collapse
Affiliation(s)
- Andrew C Smith
- Northwestern University Interdepartmental Neuroscience Program, Chicago, IL, 60611, USA
| | | | | |
Collapse
|
81
|
Smith AC, Mummidisetty CK, Rymer WZ, Knikou M. Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury. J Neurophysiol 2014; 112:2164-75. [PMID: 25122715 DOI: 10.1152/jn.00308.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In humans, a chronic spinal cord injury (SCI) impairs the excitability of pathways mediating early flexor reflexes and increases the excitability of late, long-lasting flexor reflexes. We hypothesized that in individuals with SCI, locomotor training will alter the behavior of these spinally mediated reflexes. Nine individuals who had either chronic clinically motor complete or incomplete SCI received an average of 44 locomotor training sessions. Flexor reflexes, elicited via sural nerve stimulation of the right or left leg, were recorded from the ipsilateral tibialis anterior (TA) muscle before and after body weight support (BWS)-assisted treadmill training. The modulation pattern of the ipsilateral TA responses following innocuous stimulation of the right foot was also recorded in 10 healthy subjects while they stepped at 25% BWS to investigate whether body unloading during walking affects the behavior of these responses. Healthy subjects did not receive treadmill training. We observed a phase-dependent modulation of early TA flexor reflexes in healthy subjects with reduced body weight during walking. The early TA flexor reflexes were increased at heel contact, progressively decreased during the stance phase, and then increased throughout the swing phase. In individuals with SCI, locomotor training induced the reappearance of early TA flexor reflexes and changed the amplitude of late TA flexor reflexes during walking. Both early and late TA flexor reflexes were modulated in a phase-dependent pattern after training. These new findings support the adaptive capability of the injured nervous system to return to a prelesion excitability and integration state.
Collapse
Affiliation(s)
- Andrew C Smith
- Northwestern University Interdepartmental Neuroscience Program, Chicago, Illinios
| | | | - William Zev Rymer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; Northwestern University Interdepartmental Neuroscience Program, Chicago, Illinios; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg Medical School, Chicago, Illinois
| | - Maria Knikou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg Medical School, Chicago, Illinois; Graduate Center/The City University of New York, New York, New York; and Department of Physical Therapy, College of Staten Island, Staten Island, New York
| |
Collapse
|
82
|
Senthilvelkumar T, Magimairaj H, Fletcher J, Tharion G, George J. Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial. Clin Rehabil 2014; 29:42-9. [DOI: 10.1177/0269215514538068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To compare the effectiveness of body weight-supported treadmill training and body weight-supported overground training for improving gait and strength in people with traumatic incomplete tetraplegia. Design: Assessor blinded randomized trial. Setting: Rehabilitation institute of a tertiary care teaching hospital in India. Participants: Sixteen participants with traumatic motor incomplete tetraplegia and within two years of injury. Interventions: Participants were randomised to one of two groups: body weight-supported overground training on level ground and body weight-supported treadmill training. Both groups received 30 minutes of gait training per day, five days a week for eight weeks. In addition, both groups received regular rehabilitation which included flexibility, strength, balance, self care and functional training. Outcome measures: The primary outcome measure was the Walking Index for Spinal Cord Injury (/20 points) and the secondary outcome was the Lower Extremity Muscle Score (/50 points). Results: There was no statistically significant between group differences in the Walking Index for Spinal Cord Injury [mean difference=0.3points; 95% CI (-4.8 to 5.4); p=0.748] or the Lower Extremity Muscle Score [mean difference=0.2 points; 95% CI (-3.8 to 5.1); p=0.749]. Conclusions: Gait training with body weight-supported overground training is comparable to treadmill training for improving locomotion in people with traumatic incomplete tetraplegia.
Collapse
Affiliation(s)
- Thangavelu Senthilvelkumar
- Physical Therapy Unit, Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College, Tamil Nadu, India
| | - Henry Magimairaj
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Tamil Nadu, India
| | - Jebaraj Fletcher
- Physical Therapy Unit, Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College, Tamil Nadu, India
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Tamil Nadu, India
| | - Jacob George
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Tamil Nadu, India
| |
Collapse
|
83
|
Serotonergic transmission after spinal cord injury. J Neural Transm (Vienna) 2014; 122:279-95. [PMID: 24866695 DOI: 10.1007/s00702-014-1241-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/06/2014] [Indexed: 12/27/2022]
Abstract
Changes in descending serotonergic innervation of spinal neural activity have been implicated in symptoms of paralysis, spasticity, sensory disturbances and pain following spinal cord injury (SCI). Serotonergic neurons possess an enhanced ability to regenerate or sprout after many types of injury, including SCI. Current research suggests that serotonine (5-HT) release within the ventral horn of the spinal cord plays a critical role in motor function, and activation of 5-HT receptors mediates locomotor control. 5-HT originating from the brain stem inhibits sensory afferent transmission and associated spinal reflexes; by abolishing 5-HT innervation SCI leads to a disinhibition of sensory transmission. 5-HT denervation supersensitivity is one of the key mechanisms underlying the increased motoneuron excitability that occurs after SCI, and this hyperexcitability has been demonstrated to underlie the pathogenesis of spasticity after SCI. Moreover, emerging evidence implicates serotonergic descending facilitatory pathways from the brainstem to the spinal cord in the maintenance of pathologic pain. There are functional relevant connections between the descending serotonergic system from the rostral ventromedial medulla in the brainstem, the 5-HT receptors in the spinal dorsal horn, and the descending pain facilitation after tissue and nerve injury. This narrative review focussed on the most important studies that have investigated the above-mentioned effects of impaired 5-HT-transmission in humans after SCI. We also briefly discussed the promising therapeutical approaches with serotonergic drugs, monoclonal antibodies and intraspinal cell transplantation.
Collapse
|
84
|
D'Amico JM, Condliffe EG, Martins KJB, Bennett DJ, Gorassini MA. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity. Front Integr Neurosci 2014; 8:36. [PMID: 24860447 PMCID: PMC4026713 DOI: 10.3389/fnint.2014.00036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/17/2014] [Indexed: 01/08/2023] Open
Abstract
The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI.
Collapse
Affiliation(s)
- Jessica M D'Amico
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada
| | - Elizabeth G Condliffe
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada ; Division of Physical Medicine and Rehabilitation, University of Alberta Edmonton, AB, Canada
| | - Karen J B Martins
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Physical Education and Recreation, University of Alberta Edmonton, AB, Canada
| | - David J Bennett
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Rehabilitation Medicine, University of Alberta Edmonton, AB, Canada
| | - Monica A Gorassini
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada
| |
Collapse
|
85
|
Varoqui D, Niu X, Mirbagheri MM. Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury. J Neuroeng Rehabil 2014; 11:46. [PMID: 24684813 PMCID: PMC3974744 DOI: 10.1186/1743-0003-11-46] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities-characterized by increases in the over-ground walking speed and endurance-is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. METHODS Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient's maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients. RESULTS After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments. CONCLUSIONS The improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI.
Collapse
Affiliation(s)
- Deborah Varoqui
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Xun Niu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Mehdi M Mirbagheri
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| |
Collapse
|
86
|
Taveggia G, Villafañe JH, Vavassori F, Lecchi C, Borboni A, Negrini S. Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial. J Manipulative Physiol Ther 2014; 37:242-52. [PMID: 24656867 DOI: 10.1016/j.jmpt.2013.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/23/2013] [Accepted: 09/20/2013] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of the application of analyzing treadmill, muscle strengthening, and balance training compared with a standard care intervention in patients with diabetic neuropathy. METHODS Twenty-seven patients, 63% female (mean ± standard deviations age, 72 ±9 years), with diabetic neuropathy randomly assigned to receive a multimodal manual treatment approach including analyzing treadmill with feedback focused, isokinetic dynamometric muscle strengthening, and balance retraining on dynamic balance platform or a standard care intervention for activities targeted to improve endurance, manual exercises of muscle strengthening, stretching exercises, gait, and balance exercises (5 weekly over 4 weeks). This study was designed as a double-blind, randomized clinical trial. Measures were assessed at pretreatment, 4 weeks posttreatment, and 2-month follow-up. RESULTS No important baseline differences were observed between groups. At the end of the treatment period, the experimental group showed a significant increase in gait endurance in a 6-minute walk test, 65.6 m (F[2.0] = 9.636; P = .001). In addition, the 6-minute walk test increased after the intervention, and an even greater difference was found at follow-up (P = .005) for the standard care group. The Functional Independence Measure in both groups increased (P < .01) and continued until the follow-up in the standard care group (P = .003). CONCLUSIONS The results suggest that the experimental rehabilitation program showed positive effects on the gait endurance after 4 weeks of treatment, whereas it did not produce significant improvements of the gait speed. Both the treatments produced significant improvement of functionalities of the patient.
Collapse
Affiliation(s)
- Giovanni Taveggia
- Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy
| | | | - Francesca Vavassori
- Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy
| | - Cristina Lecchi
- Professor/Physician, Habilita, Istituto Clinico Ospedale di Sarnico, Sarnico, Italy
| | - Alberto Borboni
- Researcher, Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy.
| | - Stefano Negrini
- Researcher, IRCCS Don Gnocchi Foundation, Milan, Italy; Professor/Physician, Director, Physical and Rehabilitation Medicine, University of Brescia, Brescia, Italy
| |
Collapse
|
87
|
Knikou M, Mummidisetty CK. Locomotor training improves premotoneuronal control after chronic spinal cord injury. J Neurophysiol 2014; 111:2264-75. [PMID: 24598526 DOI: 10.1152/jn.00871.2013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Spinal inhibition is significantly reduced after spinal cord injury (SCI) in humans. In this work, we examined if locomotor training can improve spinal inhibition exerted at a presynaptic level. Sixteen people with chronic SCI received an average of 45 training sessions, 5 days/wk, 1 h/day. The soleus H-reflex depression in response to low-frequency stimulation, presynaptic inhibition of soleus Ia afferent terminals following stimulation of the common peroneal nerve, and bilateral EMG recovery patterns were assessed before and after locomotor training. The soleus H reflexes evoked at 1.0, 0.33, 0.20, 0.14, and 0.11 Hz were normalized to the H reflex evoked at 0.09 Hz. Conditioned H reflexes were normalized to the associated unconditioned H reflex evoked with subjects seated, while during stepping both H reflexes were normalized to the maximal M wave evoked after the test H reflex at each bin of the step cycle. Locomotor training potentiated homosynaptic depression in all participants regardless the type of the SCI. Presynaptic facilitation of soleus Ia afferents remained unaltered in motor complete SCI patients. In motor incomplete SCIs, locomotor training either reduced presynaptic facilitation or replaced presynaptic facilitation with presynaptic inhibition at rest. During stepping, presynaptic inhibition was modulated in a phase-dependent manner. Locomotor training changed the amplitude of locomotor EMG excitability, promoted intralimb and interlimb coordination, and altered cocontraction between knee and ankle antagonistic muscles differently in the more impaired leg compared with the less impaired leg. The results provide strong evidence that locomotor training improves premotoneuronal control after SCI in humans at rest and during walking.
Collapse
Affiliation(s)
- Maria Knikou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg Medical School, Chicago, Illinois; Graduate Center/The City University of New York, New York, New York; and Department of Physical Therapy, College of Staten Island, Staten Island, New York
| | | |
Collapse
|
88
|
Málly J, Stone TW. New advances in the rehabilitation of CNS diseases applying rTMS. Expert Rev Neurother 2014. [DOI: 10.1586/14737175.7.2.165\] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
89
|
Dutra CMR, Dutra CMR, Moser ADDL, Manffra EF. Treino locomotor com suporte parcial de peso corporal na reabilitação da lesão medular: revisão da literatura. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O treino locomotor com suporte de peso corporal (TLSP) é utilizado há aproximadamente 20 anos no campo da reabilitação em pacientes que sofrem de patologias neurológicas. O TLSP favorece melhoras osteomusculares, cardiovasculares e psicológicas, pois desenvolve ao máximo o potencial residual do organismo, proporcionando a reintegração na convivência familiar, profissional e social. OBJETIVO: Identificar as principais modalidades de TLSP e seus parâmetros de avaliação com a finalidade de contribuir com o estabelecimento de evidências confiáveis para as práticas reabilitativas de pessoas com lesão medular. MATERIAIS E MÉTODOS: Foram analisados artigos originais, publicados entre 2000 e 2011, que envolvessem treino de marcha após a lesão medular, com ou sem suporte parcial de peso corporal, e tecnologias na assistência do treino, como biofeedback e estimulação elétrica funcional, entre outras. RESULTADOS: A maioria dos participantes dos estudos era do sexo masculino; os níveis de lesão variavam de C3 a L3; ASIA teve pontuações de A a D; os tempos de lesão variaram entre 0,3 meses a 33 anos. Também se verificou que não há consenso em relação ao protocolo de TLSP. CONCLUSÃO: O treino locomotor com suporte de peso corporal mostra-se viável na reabilitação de pacientes que sofrem de uma patologia neurológica como a lesão medular. Independentemente do protocolo de treino utilizado, os benefícios referentes ao aumento da força muscular, manutenção ou aumento da densidade óssea, diminuição da frequência cardíaca e aumento do condicionamento físico estão presentes
Collapse
|
90
|
de Paleville DT, McKay W, Aslan S, Folz R, Sayenko D, Ovechkin AV. Locomotor step training with body weight support improves respiratory motor function in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2013; 189:491-7. [PMID: 23999001 PMCID: PMC3833892 DOI: 10.1016/j.resp.2013.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/19/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
This prospective case-controlled clinical study was undertaken to investigate to what extent the manually assisted treadmill stepping locomotor training with body weight support (LT) can change respiratory function in individuals with chronic spinal cord injury (SCI). Pulmonary function outcomes (forced vital capacity /FVC/, forced expiratory volume one second /FEV1/, maximum inspiratory pressure /PImax/, maximum expiratory pressure /PEmax/) and surface electromyographic (sEMG) measures of respiratory muscles activity during respiratory tasks were obtained from eight individuals with chronic C3-T12 SCI before and after 62±10 (mean±SD) sessions of the LT. FVC, FEV1, PImax, PEmax, amount of overall sEMG activity and rate of motor unit recruitment were significantly increased after LT (p<0.05). These results suggest that these improvements induced by the LT are likely the result of neuroplastic changes in spinal neural circuitry responsible for the activation of respiratory muscles preserved after injury.
Collapse
Affiliation(s)
| | - William McKay
- Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, GA, USA
| | - Sevda Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Rodney Folz
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, KY, USA
| | - Dimitry Sayenko
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | | |
Collapse
|
91
|
Yang JF, Musselman KE, Livingstone D, Brunton K, Hendricks G, Hill D, Gorassini M. Repetitive mass practice or focused precise practice for retraining walking after incomplete spinal cord injury? A pilot randomized clinical trial. Neurorehabil Neural Repair 2013; 28:314-24. [PMID: 24213960 DOI: 10.1177/1545968313508473] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Retraining walking following spinal cord injury using visually guided tasks may be especially efficacious because it engages the motor cortex, whose input may facilitate improvements in functional walking. OBJECTIVES To contrast 2 methods of retraining, one emphasizing precise, visually guided walking over obstacles and on targets (Precision Training), the other emphasizing mass practice of walking on a treadmill (Endurance Training). METHODS A randomized, single-blind, crossover design was used. Twenty-two participants, ≥7 months postinjury, were randomly allocated to start with Precision or Endurance Training. Each phase of training was 5 times per week for 2 months, followed by a 2-month rest. MEASURES of walking speed, distance, skill, confidence, and depression were obtained before training, then monthly thereafter. RESULTS Both forms of training led to significant improvements in walking, with Endurance Training inducing bigger improvements in walking distance than Precision Training, especially for high-functioning walkers who had initial walking speeds >0.5 m/s. The largest improvements in walking speed and distance occurred in the first month of Endurance Training, with minimal changes in the second month of training. In contrast, improvements in walking skill occurred over both months during both types of training. Retention of over ground walking speed, distance, and skill was excellent for both types of training. CONCLUSIONS Intensive walking training in the chronic phase after spinal cord injury is effective in improving over ground walking. Visually guided tasks for training individuals with chronic spinal cord injury were not superior to mass practice on a treadmill.
Collapse
|
92
|
Abstract
The purpose of this review is to discuss the achievements and perspectives regarding rehabilitation of sensorimotor functions after spinal cord injury. In the first part we discuss clinical approaches based on neuroplasticity, a term referring to all adaptive and maladaptive changes within the sensorimotor systems triggered by a spinal cord injury. Neuroplasticity can be facilitated through the training of movements with assistance as needed, and/or by electrical stimulation techniques. The success of such training in individuals with incomplete spinal cord injury critically depends on the presence of physiological proprioceptive input to the spinal cord leading to meaningful muscle activations during movement performances. The addition of rehabilitation technology, such as robotic devices allows for longer training times and provision of feedback information regarding changes in movement performance. Nevertheless, the improvement of function by such approaches for rehabilitation is limited. In the second part, we discuss preclinical approaches to restore function by compensating for the loss of descending input to spinal networks following complete spinal cord injury. This can be achieved with stimulation of spinal networks or approaches to restore their descending input. Electrical and pharmacological stimulation of spinal neural networks is still in an experimental stage; and despite promising repair studies in animal models, translations to humans up to now have not been convincing. It is likely that combinations of techniques targeting the promotion of axonal regeneration and meaningful plasticity are necessary to advance the restoration of function. In the future, refinement of animal studies may contribute to greater translational success.
Collapse
Affiliation(s)
- Volker Dietz
- 1 Spinal Cord Injury Centre, University Hospital Balgrist, Zürich, Switzerland
| | | |
Collapse
|
93
|
Fatigue-induced motor cortex excitability changes in subjects with spinal cord injury. Brain Res Bull 2013; 99:9-12. [DOI: 10.1016/j.brainresbull.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/03/2013] [Accepted: 09/05/2013] [Indexed: 12/21/2022]
|
94
|
Barthélemy D, Knudsen H, Willerslev-Olsen M, Lundell H, Nielsen JB, Biering-Sørensen F. Functional implications of corticospinal tract impairment on gait after spinal cord injury. Spinal Cord 2013; 51:852-6. [DOI: 10.1038/sc.2013.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/19/2013] [Accepted: 06/27/2013] [Indexed: 11/09/2022]
|
95
|
Facilitation of corticospinal connections in able-bodied people and people with central nervous system disorders using eight interventions. J Clin Neurophysiol 2013; 30:66-78. [PMID: 23377445 DOI: 10.1097/wnp.0b013e31827ed6bd] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Voluntary contractions (VOL), functional electrical stimulation (FES), and transcranial magnetic stimulation (TMS) can facilitate corticospinal connections. OBJECTIVE To find the best methods for increasing corticospinal excitability by testing eight combinations: (1) VOL, (2) FES, (3) FES + VOL, (4) TMS, (5) TMS + VOL, (6) paired associative stimulation (PAS) consisting of FES + TMS, (7) PAS + VOL, and (8) double-pulse TMS + VOL. METHODS Interventions were applied for 3 × 10 minutes in 15 able-bodied subjects, 14 subjects with stable central nervous system lesions (e.g., chronic stroke, and incomplete spinal cord injury) and 16 subjects with progressive central nervous system conditions (e.g., secondary progressive multiple sclerosis). Motor-evoked potentials (MEP), M-waves, and H-reflexes were monitored over a 1-hour period. RESULTS Three interventions (PAS, PAS + VOL, and double-pulse TMS + VOL) caused 15% to 20% increases (P < 0.05) in the MEP at a stimulus level that initially produced a half-maximal response (MEP(half)) during a contraction. Interventions were less effective in both clinical groups than in the able-bodied group. Interventions with VOL were more effective in increasing the MEP(half) than those without (P = 0.022). When more modalities were combined, the MEP increases were larger (P = 0.022). CONCLUSIONS (1) Short-term application of FES, TMS, and VOL can facilitate corticospinal pathways, particularly when methods are combined. (2) The effects may depend on the total activation of neural pathways, which is reduced in central nervous system disorders.
Collapse
|
96
|
Fouad K, Tse A. Adaptive changes in the injured spinal cord and their role in promoting functional recovery. Neurol Res 2013; 30:17-27. [DOI: 10.1179/016164107x251781] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
97
|
Martinez M, Delivet-Mongrain H, Rossignol S. Treadmill training promotes spinal changes leading to locomotor recovery after partial spinal cord injury in cats. J Neurophysiol 2013; 109:2909-22. [DOI: 10.1152/jn.01044.2012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
After a spinal hemisection at thoracic level in cats, the paretic hindlimb progressively recovers locomotion without treadmill training but asymmetries between hindlimbs persist for several weeks and can be seen even after a further complete spinal transection at T13. To promote optimal locomotor recovery after hemisection, such asymmetrical changes need to be corrected. In the present study we determined if the locomotor deficits induced by a spinal hemisection can be corrected by locomotor training and, if so, whether the spinal stepping after the complete spinal cord transection is also more symmetrical. This would indicate that locomotor training in the hemisected period induces efficient changes in the spinal cord itself. Sixteen adult cats were first submitted to a spinal hemisection at T10. One group received 3 wk of treadmill training, whereas the second group did not. Detailed kinematic and electromyographic analyses showed that a 3-wk period of locomotor training was sufficient to improve the quality and symmetry of walking of the hindlimbs. Moreover, after the complete spinal lesion was performed, all the trained cats reexpressed bilateral and symmetrical hindlimb locomotion within 24 h. By contrast, the locomotor pattern of the untrained cats remained asymmetrical, and the hindlimb on the side of the hemisection was still deficient. This study highlights the beneficial role of locomotor training in facilitating bilateral and symmetrical functional plastic changes within the spinal circuitry and in promoting locomotor recovery after an incomplete spinal cord injury.
Collapse
Affiliation(s)
- Marina Martinez
- Groupe de Recherche sur le Système Nerveux Central (Fonds de la Recherche en Santé du Québec), Département de Physiologie, Université de Montréal, Montreal, Quebec, Canada; and
- SensoriMotor Rehabilitation Research Team, Canadian Institutes of Health Research, Montreal, Quebec, Canada
| | - Hugo Delivet-Mongrain
- Groupe de Recherche sur le Système Nerveux Central (Fonds de la Recherche en Santé du Québec), Département de Physiologie, Université de Montréal, Montreal, Quebec, Canada; and
| | - Serge Rossignol
- Groupe de Recherche sur le Système Nerveux Central (Fonds de la Recherche en Santé du Québec), Département de Physiologie, Université de Montréal, Montreal, Quebec, Canada; and
- SensoriMotor Rehabilitation Research Team, Canadian Institutes of Health Research, Montreal, Quebec, Canada
| |
Collapse
|
98
|
Yang JF, Livingstone D, Brunton K, Kim D, Lopetinsky B, Roy F, Zewdie E, Patrick SK, Andersen J, Kirton A, Watt JM, Yager J, Gorassini M. Training to enhance walking in children with cerebral palsy: are we missing the window of opportunity? Semin Pediatr Neurol 2013; 20:106-15. [PMID: 23948685 DOI: 10.1016/j.spen.2013.06.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this paper is to (1) identify from the literature a potential critical period for the maturation of the corticospinal tract (CST) and (2) report pilot data on an intensive, activity-based therapy applied during this period, in children with lesions to the CST. The best estimate of the CST critical period for the legs is when the child is younger than 2 years of age. Previous interventions for walking in children with CST damage were mainly applied after this age. Our preliminary results with training children younger than 2 years showed improvements in walking that exceeded all previous reports. Further, we refined techniques for measuring motor and sensory pathways to and from the legs, so that changes can be measured at this young age. Previous activity-based therapies may have been applied too late in development. A randomized controlled trial is now underway to determine if intensive leg therapy improves the outcome of children with early stroke.
Collapse
Affiliation(s)
- Jaynie F Yang
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Knikou M. Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury. Exp Brain Res 2013; 228:279-96. [PMID: 23708757 DOI: 10.1007/s00221-013-3560-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 05/02/2013] [Indexed: 12/14/2022]
Abstract
Body weight-supported (BWS) robotic-assisted step training on a motorized treadmill is utilized with the aim to improve walking ability in people after damage to the spinal cord. However, the potential for reorganization of the injured human spinal neuronal circuitry with this intervention is not known. The objectives of this study were to determine changes in the soleus H-reflex modulation pattern and activation profiles of leg muscles during stepping after BWS robotic-assisted step training in people with chronic spinal cord injury (SCI). Fourteen people who had chronic clinically complete, motor complete, and motor incomplete SCI received an average of 45 training sessions, 5 days per week, 1 h per day. The soleus H-reflex was evoked and recorded via conventional methods at similar BWS levels and treadmill speeds before and after training. After BWS robotic-assisted step training, the soleus H-reflex was depressed at late stance, stance-to-swing transition, and swing phase initiation, allowing a smooth transition from stance to swing. The soleus H-reflex remained depressed at early and mid-swing phases of the step cycle promoting a reciprocal activation of ankle flexors and extensors. The spinal reflex circuitry reorganization was, however, more complex, with the soleus H-reflex from the right leg being modulated either in a similar or in an opposite manner to that observed in the left leg at a given phase of the step cycle after training. Last, BWS robotic-assisted step training changed the amplitude and onset of muscle activity during stepping, decreased the step duration, and improved the gait speed. BWS robotic-assisted step training reorganized spinal locomotor neuronal networks promoting a functional amplitude modulation of the soleus H-reflex and thus step progression. These findings support that spinal neuronal networks of persons with clinically complete, motor complete, or motor incomplete SCI have the potential to undergo an endogenous-mediated reorganization, and improve spinal reflex function and walking function with BWS robotic-assisted step training.
Collapse
Affiliation(s)
- Maria Knikou
- Electrophysiological Analysis of Gait and Posture Laboratory, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Suite 1406, Chicago, IL 60611, USA.
| |
Collapse
|
100
|
Hillen BK, Abbas JJ, Jung R. Accelerating locomotor recovery after incomplete spinal injury. Ann N Y Acad Sci 2013; 1279:164-74. [PMID: 23531014 DOI: 10.1111/nyas.12061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A traumatic spinal injury can destroy cells, irreparably damage axons, and trigger a cascade of biochemical responses that increase the extent of injury. Although damaged central nervous system axons do not regrow well naturally, the distributed nature of the nervous system and its capacity to adapt provide opportunities for recovery of function. It is apparent that activity-dependent plasticity plays a role in this recovery and that the endogenous response to injury heightens the capacity for recovery for at least several weeks postinjury. To restore locomotor function, researchers have investigated the use of treadmill-based training, robots, and electrical stimulation to tap into adaptive activity-dependent processes. The current challenge is to maximize the degree of functional recovery. This manuscript reviews the endogenous neural system response to injury, and reviews data and presents novel analyses of these from a rat model of contusion injury that demonstrates how a targeted intervention can accelerate recovery, presumably by engaging processes that underlie activity-dependent plasticity.
Collapse
Affiliation(s)
- Brian K Hillen
- Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA
| | | | | |
Collapse
|